Summary of Benefits and Coverage
| Overview
Coventry Health Care of Virginia, Inc. has been developing processes in response to the Affordable Care Act (ACA) regulations regarding the preparation of a Summary of Benefits and Coverage (SBC) document that follows a prescribed template created by the government. Supplying consumers with SBCs in a standardized format will give them a more simple and consistent way to compare health plans and make informed decisions about health care coverage.
An example of an SBC is available on the U.S. Department of Labor website: http://www.dol.gov/ebsa/pdf/CorrectedSampleCompletedSBC.pdf
Effective Date
The ACA regulations apply to both fully insured and self-insured plans:
- Enrollment periods that begin on or after September 23, 2012
- New hires and special enrollments on the first day of the first plan year starting on or after September 23, 2012
Distribution: Fully Insured Employer Groups
We believe the most effective way to comply with these regulations is for Coventry Health Care of Virginia, Inc. and the employer group to share tasks, according to our respective capabilities. Our plan: We will prepare the SBC for employer groups, and groups will distribute to participants and beneficiaries. An agreement about SBC preparation and distribution will be mailed to fully insured employer groups in July. These agreements need to be reviewed, signed and returned by the following dates:- Employer groups with enrollment periods from October to January 13 will need to sign and return the SBC Stand Alone Agreement to Coventry by August 1, 2012.
- Employer groups with enrollment periods from February to September 13 will need to sign and return the SBC Stand Alone Agreement to Coventry by August 6, 2012.
Coventry Health Care of Virginia, Inc. will deliver SBCs to employer groups with quotes for new and renewing policies. In other words, if the quote is sent via email, the SBC will accompany the email. If the employer group requests a particular form (e.g., paper), we will honor that request.
Distribution: CoventryOne Policyholders
We will distribute SBCs to CoventryOne policyholders in the following manner:
When applying:
When renewing:
With the renewal letter and quote via the U.S. mail.
Timeframes
The timeframes listed below apply to employer groups distributing SBCs to employees and to Coventry Health Care of Virginia, Inc. when we distribute SBCs to individual policyholders.
Initial enrollment
- No later than seven business days after receipt of the application.
- If information changes between the application for coverage and the first day of coverage, an updated SBC needs to be provided no later than the first day of coverage.
Renewal
- For written applications, with renewal materials.
- For automatic renewals, no later than 30 days prior to the first day of the new policy year.
- Exception: if the policy is not renewed before the 30-day period, no later than seven business days after issuance of the policy or receipt of written confirmation of intent to renew, whichever is latest.
Special enrollment (not applicable to individual policies)
- No later than 90 days from enrollment.
Upon request
- No later than seven business days after the request for plan years starting on or after September 23, 2012.
We encourage you to visit our corporate website at www.cvty.com to stay abreast of changes resulting from health care reform.
|
Coventry Consumer ChoiceSM (C3) Reporting Improvements
| Coventry Consumer Choice (C3) would like to inform you of upcoming changes to the C3 employer portal accessed through Online Account Management (OAM). These changes are scheduled for implementation on July 13, 2012.
First, we are changing the name of the Check Register report to Payment Detail Report to more clearly reflect its purpose. As a reminder, there are two versions available, a PDF version and CSV version.
In addition to renaming this report, there is an enhancement to the data provided. Future reports will include a new Reissue column. An "R" in this column will indicate that the check has been reissued. For example, if a C3 reimbursement is lost in the mail, a stop payment is placed on the original check and C3 reissues another check. The new Reissue column will make it easier for you to identify these transactions. The CSV version will contain the original check number, as well as the Reissue indicator.
The enhancements to the PDF and CSV files will impact future reports; those previously posted will not be updated.
Clarification on Salary Reduction Limits for Flexible Spending Accounts
In addition, C3 previously communicated that under health care reform regulations, there will be a $2,500 limit on annual salary reduction contributions to health care flexible spending accounts (HC-FSAs) effective January 1, 2013. The IRS recently clarified how the new limit will impact current HC-FSA members. The change will be in effect at the start of the employer group's plan year in 2013, not the 2013 calendar year. The attached flyer outlines the changes and provides an example of how the plan year limit will apply.
C3 continues to improve the health benefits experience for employers, members and providers. If you have questions, please contact your Coventry representative.
|
Safe Senders
| |
If you are not receiving emails notifying you that a new commission statement is available, please check to make sure that the email address coventrycommissions@cvty.com is in your "safe senders" list. Do not send an email to this address. Instead, call 800.438.4029 for any questions regarding commissions.
|
| | PPO products are underwritten by Coventry Health and Life Insurance Company and administered by Coventry Health Care of Virginia, Inc. |
|
 |
Charlottesville Office:
434.951.2500
Richmond Office:
804.747.3700
|
|
